Mediation Feedback Form

We thank you for your time to complete this Feedback, which will take approximately 5 to 10 minutes.

Your feedback is an integral and important part of iiM’s Mediation Procedure. Your inputs on your experience of the mediation process, with reason(s), will:

  1. help us and our Mediator(s) improve our service, and
  2. help us verify the mediation process for our Mediator’s progression and credential.

When selecting from a range of options, please mark your selection with a tick " ☑ ".

Your Name
Mediator’s Name
Venue of Mediation
Date/Time of Mediation Start Date & Time :
End Date & Time :
Nature of Mediated Matter

Please answer the following questions by ticking the box that most accurately reflects how you feel.

   

1.The mediation process, which include Opening statement by Mediator, joint and private sessions, exploring of options and closing, was clearly explained to me from the start

Strongly Agree Agree Unsure Disagree Strongly Disagree
Further Comments:

2. The mediation information given to me by the Mediator was clear and easy to understand

Strongly Agree Agree Unsure Disagree Strongly Disagree
Further Comments:

3. I felt comfortable that confidentiality was respected at all times

Strongly Agree Agree Unsure Disagree Strongly Disagree
Further Comments:

4. Following the mediation my understanding of the issue arising from the matter has improved

Strongly Agree Agree Unsure Disagree Strongly Disagree
Further Comments:

5. The Mediator….(please tick any of the boxes that you agree with, and /or provide feedback below)

Was impartial Helped me expressed my views Helped us to identify and consider options Listened to us attentively Was Professional
Further Comments:

6. I would recommend the mediation service to a colleague

Agree Disagree

7. What would have improved the mediation service / experience for you?

Comments:

8. Overall, I would rate the mediation service as effective

Strongly Agree Agree Unsure Disagree Strongly Disagree
Further Comments:

9. Any additional comments you would like to make:

Yes No

Please pass this to our attending staff or the Mediator(s).

Name: Name:
NRIC No. NRIC No.
Date: Date: